Provider Demographics
NPI:1114919131
Name:RAIMAN, PAUL J (MD)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:J
Last Name:RAIMAN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1234 E DUPONT RD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46825-1545
Mailing Address - Country:US
Mailing Address - Phone:260-373-9700
Mailing Address - Fax:260-373-9740
Practice Address - Street 1:11141 PARKVIEW PLAZA DR
Practice Address - Street 2:SUITE 310
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46845-1701
Practice Address - Country:US
Practice Address - Phone:260-489-8898
Practice Address - Fax:260-373-4695
Is Sole Proprietor?:No
Enumeration Date:2005-08-16
Last Update Date:2013-03-23
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IN01034793A208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000614766OtherANTHEM
IN020037713OtherRR MEDICARE
IN100096150Medicaid
IN100096150AMedicaid
IN000000595629OtherANTHEM
OH0610888Medicaid
IN000000595629OtherANTHEM
IN020037713OtherRR MEDICARE
OH0610888Medicaid